Healthcare Provider Details

I. General information

NPI: 1669965000
Provider Name (Legal Business Name): JORDAN ROBERSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN ROGERS ARNP

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 N CLYDE MORRIS BLVD STE 300
DAYTONA BEACH FL
32117-5533
US

IV. Provider business mailing address

1737 N CLYDE MORRIS BLVD STE 300
DAYTONA BEACH FL
32117-5533
US

V. Phone/Fax

Practice location:
  • Phone: 386-262-1627
  • Fax:
Mailing address:
  • Phone: 386-262-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9410928
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9410928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: